The importance of penis panics to cultural psychiatry

The Boston Globe has an excellent article about supposedly culture specific mental illnesses and how they are an ongoing puzzle for psychiatry’s diagnostic manual.

These conditions are called culture-bound syndromes in the DSM but they’ve always had a bit of ‘looking at the natives’ feel about them as many syndromes that are unknown in many non-Western cultures (anorexia, for example) aren’t listed as ‘culture bound’ in any way.

The Boston Globe article reminded me of a paper just published in the Journal of the History of Medicine and Allied Sciences by historian Ivan Crozier where he explores how koro – the fear that the genitals are fatally shrinking into the body – has been central to the definition of the ‘culture-bound syndrome’.

The history of how this fear, usually presenting as a penis shrinking anxiety and initially reported in South East Asia, became a prime example of a supposedly culture-specific mental illness, highlighting a bias at the centre of psychiatric definitions.

Penis shrinking fears have been reported from all over the world, but only certain cases tend to get defined as a ‘culture-specific syndrome’, because of our assumptions about what counts as the ‘real’ disorder.

Koro is a particularly good syndrome with which to play up the tension between psychiatric universalism on the one hand, and ethnic bias on the other. This disruption is clear when one surveys the varieties of koro. Some people (SE Asians) have koro because they belong to the “right” culture. Others do not, because they are suffering from another primary disorder (occidental sufferers), or because there is little in the way of psychiatric provision in their country (e.g., in Africa), and because there are other working explanations for dealing with penis panics (such as witchcraft).

Likewise, sometimes the material artifacts of masculinity are of crucial importance for explaining koro as a part of a culture (the penis clamps and piercings in Asia), but not in others (the pills western men can take when they are concerned about the penis size). These differences in treatment are not trivial. They point to an ethnocentrism in psychiatric conceptions of illness that is embodied in the DSM IV in the very place that is meant to address culture: the CBSs [culture-bound syndromes section].

Sadly, the Crozier’s academic article is locked behind a paywall (demonstrating a strange culture bound syndrome endemic in Western academia) but The Boston Globe article in free to access.